1. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 5 Therapeutic Communication Skills

2. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Importance of Communication Therapeutic communication –Introduces element of empathy –Specific and well-defined professional skills –Foundation of all patient care –Nontechnical language –Technically accurate

3. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Communication Cycle Two or more individuals exchanging information Sending and receiving messages Four basic elements –Sender –Message and channel or mode of communication –Receiver –Feedback

4. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Communication Cycle The communication cycle and channels of communication >>

5. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Communication Cycle The sender –Encoding or creating message to be sent The message –Content being communicated –Must be understood clearly by receiver –Four modes of communication Speaking Listening Gestures or body language Writing

6. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Communication Cycle The receiver –Recipient of sender’s message –Must decode (interpret) meaning of message –Sensory skill in verbal communication is listening Feedback –After receiver has decoded message sent by sender –Receiver’s way of ensuring message that is understood is same as message sent

7. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Communication Cycle Listening skills –Active listening: received message sent back to sender, worded a little differently, for verification from sender –Listening with a “third ear”

8. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Communication Cycle Listening skills –Listening goals Improve listening skills so patients are heard accurately Listen either for what is not being said or for information transmitted only by hints Determine how accurately message has been received

9. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Communication Verbal communication –Takes place when message is spoken –Sender and receiver must apply same meaning to spoken words

10. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Communication Verbal communication –The Five Cs of communication Complete Clear Concise Cohesive Courteous

11. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Communication Verbal communication –Good communication skills necessary in establishing rapport with patients –Patients feel respected and validated when called by full name –Patients should be encouraged to verbalize their feelings and concerns

12. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Communication Verbal communication –Patients should be given technical information in manner that they can understand –Patients should be allowed to make practical application to their personal health needs

13. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Communication Nonverbal communication –Body language Unconscious body movements, gestures, facial expressions Body language can communicate more than spoken words >>

14. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Communication Nonverbal communication –Body language Expressions that accompany speech Kinesics is study of body language Body language learned first Body language influenced by primary caregivers and culture

15. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Communication Nonverbal communication –Feelings and emotions communicated through nonverbal means 70% of language is nonverbal Tone of voice communicates 23% of message Spoken word communicates 7% of message

16. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Communication Nonverbal communication –Facial expression Eyes reflect feelings Staring is invasion of privacy Cultural influences affect facial expressions –Personal space Comfortable with others while communicating Handled differently by various cultures Beneficial to explain procedures that invade another’s space

17. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Communication Nonverbal communication –Posture Relates to position of body or parts of body Involves at least half the body –Position Physical stance of two individuals while communicating Face-to-face communication Should enable observation of verbal and nonverbal cues

18. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Communication Nonverbal communication Positive posture and position encourage therapeutic communication >>

19. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Communication Nonverbal communication –Gestures and mannerisms “Talk” with hands Enhances spoken word –Touch Communicates what cannot be expressed in words Requires use of good judgment on part of professional Linked closely to personal space Not all patients are comfortable with touch

20. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Congruency in Communication Please refer to the video “Interpreting Communication” through the instructor companion site.

21. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Congruency in Communication Verbal and nonverbal messages must agree Meaning of mixed messages Clustering: grouping of nonverbal messages into statements or conclusions Masking: attempt to conceal or repress true feeling or message

22. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Congruency in Communication Perception –Conscious awareness of one’s own feelings and the feelings of others –Sense another’s attitudes, moods, feelings –Follow perceived assessments with verbal validation –Easily misinterpreted

23. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Factors Affecting Therapeutic Communication Barriers –Age –Economic –Education and life experience –Bias and prejudice –Verbal roadblocks

24. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Factors Affecting Therapeutic Communication Defense mechanisms –Regression –Denial –Repression –Projection –Sublimation –Displacement –Compensation –Rationalization –Undoing

25. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Factors Affecting Therapeutic Communication Barriers caused by cultural and religious diversity –Communication context –Caregiving expectations –Time focus –Attitude toward Western medicine

26. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Factors Affecting Therapeutic Communication Human needs as barriers to therapeutic communication Maslow’s hierarchy of needs >>

27. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Factors Affecting Therapeutic Communication Patient with special needs –English as a second language –Audio challenged –Visually challenged –Mental cognition Environmental and time factors

28. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Establishing Multicultural Communication The patient must trust the professional Steps to building trust: –Risk/trust –Conveying empathy –Showing respect –Being genuine –Active listening

29. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Establishing Multicultural Communication Cultural brokering –Bridging, linking, mediating between groups or persons through process of reducing conflict or producing change –Cultural broker serves as go-between –One who advocates on behalf of another individual or group within health care community

30. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Establishing Multicultural Communication Cultural brokering –Increase capacity of health care and mental health programs to design, implement, and evaluate culturally and linguistically competent service delivery systems –Cultural broker may assume role of medical interpreter

31. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Establishing Multicultural Communication Cultural brokering –Interpreters do not provide word-for-word equivalence, but rather focus on accurate expression of equivalent meaning –Remember to speak directly to patient, not to interpreter

32. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Establishing Multicultural Communication Cultural brokering –Family member may serve as interpreter –Family member may not understand medical terminology –Difficult for family member to share a life- threatening diagnosis or a poor prognosis

33. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Therapeutic Communication in Action Interview techniques –Closed questions: answered with simple yes or no –Open-ended questions: patient required to verbalize more information –Indirect statements: elicit response from patient without patient feeling questioned

34. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Therapeutic Communication in Action Interview techniques –Silence: gives patient time to put their feelings and thoughts into words –Feedback: words and nonverbal cues important; offer encouragement to patient to continue –Give recognition –Offer comfort

35. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Therapeutic Communication in Action Point of care techniques –Location where patient and provider or patient and office personnel physically interact –Barrier to communication is emotional tension

36. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Community Resources Need to refer patient to community resource List of community resources readily available